Youth who have experienced complex trauma—repeated and various forms of victimization, life-threatening accidents or disasters, and interpersonal losses at an early age or for prolonged periods—have difficulties forming attachments with caregivers and self-regulating emotions. A recent literature review by Julian D. Ford, Ph.D., of the University of Connecticut School of Medicine, and colleagues describes how a history of complex trauma during early life shapes an orientation toward detecting and surviving threats, resulting in impaired emotional and behavioral development among youth in secure juvenile justice settings.

Young people who are detained or incarcerated in secure juvenile justice settings often have histories of complex trauma. The authors discuss how professionals might manage facilities and programs to tailor treatment to these youth in light their traumatic experiences and problems with aggression. The authors say that, for the most part, clinicians and researchers have not systematically developed or validated trauma-informed services to help youth with a history of complex trauma and the emotional and behavioral problems associated with it. Some therapies, however, are in the early stages of development, and Ford and colleagues summarize these treatment and rehabilitation approaches.

Many experiences can induce trauma—including physical or sexual abuse or neglect, family and community violence, war, captivity, and forced displacement from home and community. Ford and colleagues explain that an individual who has experienced multiple forms of repeated trauma “operates in survival mode,” in which the brain and body have been shaped by intense and chronic stress, influencing his or her psychological and behavioral functioning. For example, typical characteristics among those with a history of complex trauma include: hypervigilance (always on the lookout for threats), episodic hyperarousal (fight-or-flight state) related to traumatic memories or triggers, disrupted mood, low tolerance for frustration and stress, problems delaying gratification, difficulties self-regulating emotion, attention and learning, and extreme impulsivity. Psychiatric research suggests that complex trauma during childhood contributes to many different adolescent and adult mental illnesses—including mood, anxiety, conduct, personality, and substance use disorders.

Ford and colleagues emphasize that although complex trauma is associated with aggression, such behavior is typically reactive—that is, centered on coping or protection of self or others—to extremely stressful and threatening environments of chronic abuse and violence. They point out that some physical and relational (verbal or unspoken threats) aggression may be proactive attempts by youth to cope or protect oneself rather than a sign of emotional callousness, as others often perceive.

An estimated 90 percent of youth in residential juvenile justice facilities report experiencing at least one trauma. According to the authors, professionals who work with detained or incarcerated youth should recognize that these individuals often have difficulties coping with stress, feelings of threat, impaired attention and impulse control, maladaptive ways of thinking (e.g., assuming aggression is the best way to deal with situations), and peers who encourage and reward problem behaviors. This constellation of problems, along with a deep lack of trust of authorities, presents significant challenges for those who work with youth in secure justice settings. However, Ford and colleagues argue that by understanding the origins and symptoms of complex trauma—and adjusting facilities, programs, and therapies to respond the needs and problems that result from it—administrators and therapists can improve care for these adolescents.

Generally, juvenile justice residential programs implement a one-size-fits-all approach to treatment. This approach includes educational, vocational, and recreational activities to enhance healthy socialization, and behavior management protocols that reduce violence and other problems. Staff members are also trained in management and crisis prevention to deal with potential problems, such as violence and suicide.

According to the authors, one way that staff can incorporate a complex-trauma perspective into programs is to build young people’s competence in self-regulation rather than assuming its presence or penalizing its absence. They can do so by fostering intensive social learning experiences and therapeutic interventions. Professionals working with youth who have experienced trauma can act as role models for self-regulation; they should encourage, reinforce, and coach youth to develop and use self-regulation skills, including dealing with stress in healthy ways, making good decisions, solving problems, and tolerating frustration. Professionals can also help youth to anticipate and reduce the trauma-related triggers for aggressive behavior and teach them how to cope with flashbacks to traumatic events.

Researchers and clinicians are also beginning to adapt therapies developed for other populations to the needs of trauma-scarred youth. For example, trauma-focused cognitive behavior therapy that has only been tested among children with histories of sexual abuse may, with adaptation, be appropriate for youth in the juvenile justice system. The treatment shows promise at reducing symptoms of post-traumatic stress disorder (PTSD) and depression and teaches coping skills to change thoughts about the trauma. The authors add that feasibility and outcome studies are needed to tailor this therapy to the reactive aggressive behavior of delinquent adolescents.

Ford and colleagues have developed an individual therapy focused on improving emotional regulation skills and support for delinquent youth called Trauma Affect Regulation: Guide for Education and Therapy (TARGET). This therapy has shown promise at reducing PTSD and anxiety symptoms, thoughts related to trauma, and problems controlling emotions. They note that two interventions—Multisystemic Therapy (MST) and Multidimensional Family Therapy (MDFT)—delivered in home or community-clinic settings have also shown promise at reducing aggression and related problems, including substance use and psychiatric symptoms, among delinquent youth. Variants of these treatments have been developed for youth in foster care (Multidimensional Treatment Foster Care) and those who have experienced trauma (Trauma Systems Therapy) and perhaps could be tailored for those in juvenile justice facilities.

For more information contact Dr. Julian D. Ford, University of Connecticut School of Medicine in Farmington, CT, JFord@uchc.edu.